Medical care received in a nursing facility or in a community setting that is expected to last at least 30 days. Unlike SLMB recipients, persons eligible for QI will have to apply every year and only those who apply before the money allotted by DMAS for this coverage runs out will be covered. This is limited Medicaid coverage for a Medicare recipient whose income is between 120% and 135% of the federal poverty limit. M0320.602.ġ All citations are to the Virginia Medicaid Claims Manual which is available on-line at at. Medicaid will pay the Medicare Part B premium only. This is limited Medicaid coverage for a Medicare recipient whose income is slightly above the QMB limit, but less than 120% of the federal poverty limit. Special Low-income Medicare Beneficiary (SLMB ). Medicaid will pay the Medicare Part B premium, deductibles and co-payments only. This is limited Medicaid coverage for a Medicare recipient whose income does not exceed 100% of the federal poverty limit. Coverage of health care costs of a person who is not receiving long-term care, such as hospital, doctor and prescription bills. NOTE: The income and resource eligibility rules are different for an individual (without a spouse) versus a married couple when one spouse needs long-term care, so those sections of the outline are divided to describe the different rules. The figures used are current as of the date of the revised outline. (804) 351-5272 or (804) Most of the dollar figures used in this outline are adjusted annually, at different times of the year, according to poverty guideline adjustments or cost of living increases. (Jay) Speer, Attorney at Law Revised 7/17 by Kathy Pryor and Davis Creef, Attorneys at Law WHEN DOES MEDICAID PAY FOR LONG-TERM CARE?Īuthored 2/04 by James W.
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